Are the immuno-stimulatory properties of Lenalidomide extinguished by co-administration of Dexamethasone?

Dexamethasone has been a mainstay of anti-myeloma therapy for 20 years. However, it is intensely immunosuppressive and may limit the efficacy of the immune system to control myeloma, and limit the exciting opportunities to use immune stimulating drug therapies such as Lenalidomide to maximize the fight against this disease. There is little doubt that the use of high dose corticosteroid therapy in the form of either dexamethasone or prednisolone when used in combination with either conventional chemotherapy, such as cyclo-phosphamide, melphalan or adriamycin, or, more latterly, novel agents such as bortezomib or lenalidomide have a major therapeutic impact in the initial therapy of multiple myeloma (MM).1 Malignant plasma cells, in common with other lymphoid cell subtypes, sho